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Subcutaneous Injections. NURS128 Instructor: Marilyn Gilbert Winter: 2006 Thank you to Sherrie Bade and Susan Ross and Laura Ford. Routes of Medication Administration. Parenteral medication: administration of a medication by injection into body tissues

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subcutaneous injections
Subcutaneous Injections

NURS128

Instructor: Marilyn Gilbert

Winter: 2006

Thank you to Sherrie Bade and Susan Ross and Laura Ford

routes of medication administration
Routes of Medication Administration
  • Parenteral medication: administration of a medication by injection into body tissues
    • Subcutaneous (SC) – into tissue below dermis of skin
    • Intramuscular (IM) – into the body muscle
    • Intravenous (IV) – into a vein
    • Intradermal (ID)– into the dermis just under the epidermis
    • Can you give examples of above?
syringes
Syringes
  • Three main parts:
    • Barrel – chamber that holds the medication
    • Plunger – part within the barrel that moves back and forth to withdraw and instill medication
    • Tip – part that the needle is attached to
  • Calibration:
    • Syringe sizes from 1 ml to 50 ml
    • Measure to a 1/10th or 1/100th depending on calibration
needles
Needles
  • Shaft of the needle
    • Length 3/8th of an inch – 1 ½ inches
    • Length chosen depends on the depth to which medication will be instilled
    • Tip of shaft is beveled or slanted to pierce the skin more easily
  • Gauge: width of the needle (18 – 27 gauge) – a smaller number indicates a larger diameter and larger lumen inside the needle
considerations when choosing a syringe and needle
Considerations when choosing a syringe and needle
  • Type of medication
  • Depth of tissue penetration required
  • Volume of medication
  • Viscosity of medication
  • Size of the client
asepsis sterile technique
Asepsis: Sterile technique
  • Sterile technique: method of creating and maintaining an area free of all pathogens (microorganisms; spores)
  • Used for all parenteral injections including subcutaneous injections
  • The primary purpose of asepsis for injections is to prevent infection
asepsis related to the syringe and needle
Asepsis related to the syringe and needle
  • Follow principles to keep needle and syringe parts sterile:
    • Shaft of the needle
    • Inside the hub of the needle
    • Tip of the syringe
    • Inside the barrel of the syringe
    • The part of the plunger entering the barrel of the syringe
asepsis of medication containers
Asepsis of Medication Containers
  • Vials: have a rubber stopper are glass or plastic - single and multidose
    • Must be cleansed with alcohol prior to inserting needle through it
    • Self sealing when needle withdrawn
    • Date outside of container when first used
  • Ampoules: glass and plastic – narrow neck that is broken – single dose
    • Neck cleansed with alcohol and broken away from you
    • Needle inserted only into opening into ampoule
assessments prior to administration of subcutaneous injection
Assessments prior to administration of subcutaneous injection
  • Use Clinical Decision Making (CDM) process:
    • Assessment – collect data (follow with analysis & synthesis of data).
    • Planning – what actions to take?
    • Implementation – carry out actions/ interventions.
    • Evaluation – did the interventions work?
pharmacokinetics
Pharmacokinetics
  • The study of how drugs:
    • Enter the body- absorption
    • Reach their site of action-distribution
    • Are metabolized-metabolism
    • Exit the body-excretion
  • Pharmacokinetics necessary influences:
    • Choice of medications for a specific client
    • Timing of drug administration
    • Selection of route for administration
dosage calculations
Dosage Calculations
  • Dose Ordered X Unit/Volume = Amount
  • Dose Available (ml, tab, cap) to give
  • D/A X unit= dose to give
the 7 rights of drug administration
The 7 Rights of Drug Administration
  • Right client
  • Right medication
  • Right dose
  • Right route
  • Right time
  • Right reason
  • Right documentation
administration of medication
Administration of Medication
  • Wash hands
  • Compare MAR with order or note RN initials present indicating order checked
  • Three checks of client name, allergies, date and time and medication
  • Calculate correct dose
  • PREPARE MEDICATION
  • Confirm right client by checking name band, asking to state name or alternatives depending on agency
  • Document on MAR [document on chart if needed]
preparing medication withdrawing from an ampoule
Preparing Medication: Withdrawing from an Ampoule
  • Tap top of ampoule to move liquid down
  • Place alcohol pad around neck of ampoule
  • Snap neck of ampoule away from you
  • Insert needle into opening – may hold upside down or on a flat service but keep needle tip under liquid
  • Remove needle – tap syringe remove air bubbles – establish dosage – may have to discard some med in sink
  • Put cap back on needle ( only cap a needle that has not been used) NEVER RECAP A USED NEEDLE
preparing medication withdrawing from a vial
Preparing Medication: Withdrawing from a Vial
  • Select appropriate syringe and needle
  • Remove cover from rubber stopper
  • Clean a pre-opened vial by swabbing it firmly with an alcohol swab - circular motion from inside to outside
  • Fill syringe with volume of air equal to volume to be withdrawn from vial
  • Insert needle – invert vial and hold/brace it while pulling on end of plunger
  • Tap barrel to remove air
  • Push on plunger to move medication to tip of needle
  • Replace cap
insulin
Insulin
  • A hormone – regulates glucose metabolism - only given parenterally (SC, IV)
  • Prescribed in units – insulin syringe calibrated in units (100 u/ml) 100 units = 1ml or 100units=1cc
  • Two sizes of syringes
    • 0.5 ml = 50 units
    • 1.0 ml = 100 units
  • Clients generally require one or more injections daily
  • Blood glucose monitoring (BGM) – A ‘normal’ range is 4 - 7
insulins
Insulins:
  • Rapid-acting:
    • Humalog: Onset – 5 minutes, Peak – 1 hour, Duration – 2-4 hours
    • Regular (Humulin R – clear): Onset – 1 hour, Peak – 2-4 hours, Duration – 5-7 hours

- Regular insulin is CLEAR

  • Intermediate-acting:
    • NPH (Humulin N – cloudy): Onset – 1 – 2.5 hours, Peak – 6-12 hours, Duration – 18-24 hours
insulins24
Insulins:
  • Long-acting Insulin (cloudy):
    • Ultralente: Onset – 4-8 hours, Peak – 12-20 hours, Duration – 24-48 hours
    • Mixed Insulins:
      • 30/70 most usual one
      • 20/80
      • 50/50

Onset – 30-60 minutes then 1-2 hours, Peak – 2-4 hours then 6-12 hours, Duration – 6-8 hours then 18-24 hours

mixing insulins
Mixing Insulins
  • Roll cloudy vial to mix
  • Cleanse rubber stoppers of both vials of insulin
  • Instill an amount of air equal to the volume that will be withdrawn from the cloudy vial
  • Repeat with clear insulin and withdraw required amount
  • Pierce cloudy vial – withdraw required units
  • Always CLEAR before CLOUDY
to ensure safe drug administration
To Ensure Safe Drug Administration
  • Focus: Don’t carry on a conversation
  • Always Check physician orders for insulin in patient`s chart
  • If uncertain ALWAYS check PRIOR to administration of a drug
  • Check for client allergies
  • Keep medications within your sight at all times
  • Withhold a medication if client demonstrating an undesirable reaction – Report and Record this
  • Record drug administration as soon as possible after medication administration
  • If an error is made, record it IMMEDIATELY so measures may be taken to minimize effects of the error – an agency incident report and TRU incident report filled out
injection technique for sc
Injection technique for SC
  • Locate site for injection
  • Cleanse with an alcohol swab cleaning from center outward in a circular motion – 5 cm

(2 in) circle

  • Clean gloves
  • Pinch up skin or spread taut depending on site and size of client
  • Dart needle quickly and firmly into tissue at either a 45° or 90° angle – stabilize by resting hand doing injection on skin surface
  • Inject medication
  • Withdraw needle quickly and immediately into sharps container – DO NOT RECAP
administration of controlled substances i e narcotics
Administration of controlled substances i.e. narcotics
  • All narcotics in locked cabinet – RN carries keys
  • When narcotic taken from cabinet documentation on ledger of:
    • Client’s name and Dr.’s name
    • Time taken from cabinet
    • The count of drug remaining
    • Signature of nurse administering – cosign for wastage
  • At change of shift oncoming and nurse completing shift do a count of all controlled substances in locked cabinet
  • Any drug discrepancies are reported immediately
common medication errors
Common Medication Errors
  • Errors in mathematical calculation of doses – check decimal point
  • Incorrect reading of labels on medications
  • Lack of knowledge about med administered
  • Failure to properly identify client before administering med or failure to listen to client – double check when a client raises questions about a medication
  • Administration of medications without critically thinking ( CT)